ADHD, currently, is considered as a developmental disorder. In each developmental stage the problems presented by individuals with ADHD is somewhat homogeneous, but in some areas each individual's presentation will be unique (Barkley, 2006a, 2006f).
Infants: An infant with ADHD may have a very high activity level even before
birth. He/she may have a very different pattern of crying. Infants with ADHD tended to cry much of the time and for a longer period of time compared to normal or other clinical control groups of children. In the first months of life an infant with ADHD either has a similar sleep pattern to premature infants - which is excessive sleeping - or has sleep difficulties which result in brief periods of quiet and deep sleep.
Compared to normal or other clinical control groups of children, infants with ADHD have low birth weight, smaller head circumference (at birth and at 12 months of age), delayed motor development, speech and language problems, and short time spans of responding to objects.
The above qualities affect ADHD infants' ability to accommodate and meet the environment’s expectations. For example, the infant who cries much of the time and has motor difficulties may also have feeding difficulties and poor nutrition because of the poor sucking and crying during feeding.
Additionally, it also affects the mother-infant relationships and cognitive development. For example, instead of being free to interact with the mother and the environment an infant with ADHD cries most of the time. (Cunningham and Barkley, 1979; Dumas and Wahler, 1985; Barkley, 2006a;
Barkley et al., 1990a; Campbell, 1990; Carey, 1970; Flick, 1998; Hartsough and Lambert, 1985; Moffitt, 1990; Nichols and Chen, 1981; Palfrey et al, 1985; Ross and Ross, 1982; Terestman, 1980; Thomas and Chess, 1977; Weiss and Hechtman, 1979, 1993; Wolff, 1969).
Preschool: In this stage, besides continued poor sleep and low tolerance for
frustration, preschoolers with ADHD begin to exhibit greater inattention and overactivity (Barkley, 2005, 2006a; Flick, 1998). By the age of four up to 40% of preschoolers with ADHD can have significant problems with inattention to a degree that their teachers and parents had strong concerns (Palfrey et al., 1985). However, the majority of these concerns fade within three to six months. Moreover, only 48% of the children who are given a clinical diagnosis of ADHD will have this same diagnosis by later childhood or early adolescence (Campbell, 1990; Palfrey et al., 1985). Therefore, based on these results, some researchers suggest that significant inattention and overactivity at the preschool stage is not indicative of a persistent pattern of ADHD into later childhood or adolescence (Campbell, 1990; Palfrey et al., 1985). However, about 10% of those children with parent and teacher concerns about inattention and overactivity can be expected to develop behaviour problems and low academic achievement which result in the need for special educational services by second grade (Barkley, 2005, 2006a; Palfrey et al, 1985).
Barkley (2006a) suggested that the duration of six months for symptoms of ADHD recommended by DSM-IV is inadequate for preschoolers. Instead, he recommended duration of twelve months when making predictions about the stability of ADHD behavioural patterns in preschool-age children.
Children with ADHD at this stage may tend to have accidental injuries because of their overactive, inattentive, impulsive, and fearless pattern of behaviour.
They may also have speech and language problems (Barkley, 2005, 2006a; Campbell, 1990).
In preschool or day care settings, preschoolers with ADHD are often characterized as being out of their seats, wandering the classroom inappropriately, vocally noisy and talkative, disrupting the play activities of other children, and excessively demanding during peer interactions (Campbell et al., 1977, 1978; Schleifer et al., 1975). Therefore, it is very often that these children are asked to leave the preschool or day care provision. However, if the child is intellectually bright or not aggressive he/she may have few or no difficulties with the demands of a typical day care or preschool programme (Barkley, 2005; Flick, 1998).
Middle childhood: At this stage youngsters with ADHD enter school. Thus
their behaviour pattern is more likely to become worse. In any school setting children are mostly expected to sit quietly, listen, obey instructions, and interact pleasantly with other children. Unfortunately, most students with ADHD lack these behaviours and skills which are essential to success in an academic curriculum. It is a very distressing period for students with ADHD and their parents because problems are likely to occur both at home and schools (Barkley, 2005; Flick, 1998).
According to Barkley (2006c) 20% to 25% of students with ADHD are likely to have a reading disorder. Additionally, they need formal special educational assistance because of their academic difficulties and 30% to 45% will be receiving it by the end of sixth grade.
Most students with ADHD find difficulties in accepting household chores and responsibilities. They also need more supervision and assistance from the
parents to accomplish daily chores and self-care activities such as bathing and dressing. Their siblings may express some jealousy because of the attention which children with ADHD required and get from their parents (Barkley, 2005).
Barkley (2006c) pointed out that children with ADHD can experience social rejection because of their poor social skills. Moreover, Ross and Ross (1982) asserted that even when children with ADHD display an appropriate behaviour towards others they mostly will experience social rejection from their peers.
Although it is not surprising that most students with ADHD tend to develop low self-esteem feelings about their school and social abilities, some students with ADHD have unrealistically positive images of themselves or have limited self-awareness which can be observed in their tendency to blame their parents, teacher, or peers when faced with difficulties instead of being realistic when weighing up what caused the problem (Barkley, 2005, 2006b).
According to Barkley social conflicts and problems are well established at this stage of development. In his words:
Between 7 and 10 years of age, at least 30% - 50% are likely to develop symptoms of conduct disorder and antisocial behaviour, such as lying, petty thievery, and resistance to the authority. Twenty-five percent or more may have problems with fighting with other children. Those who have not developed some other psychiatric, academic, or social disorder by this time are in the minority, and it is these children who are likely to have the best adolescent outcomes, experiencing problems primarily with academic performance and eventual attainment (2005, p.94).
Adolescence: According to follow-up research studies over the past decades it
is at this stage the primary characteristics of ADHD will decrease. Many students with ADHD, however, will continue to experience significant
difficulties through adolescence and into adulthood (Brown and Borden, 1986; Klein and Mannuzza, 1991; Milich and Loney, 1979; Richard, 2000; Schwean et al., 1993; Thorley, 1984; Weiss and Hechtman, 1993).
Barkley et al., (1990b) conducted an eight year detailed follow-up study of a group of ADHD children and normal children. The results are consistent with other adolescent outcome studies (e.g. Ackerman et al., 1977; Goldstein and Goldstein, 1990; Loney et al., 1981; Mendelson et al., 1971) and assert that students with ADHD are more likely to exhibit the core of ADHD symptoms which are hyperactivity, inattention, and impulsivity. Students with ADHD also have marked difficulties at school. For instance, 80% have a history of failures in one or more basic academic subject, 30% have been suspended from school at least once, and 35% quit school before completion (Ackerman et al., 1977; Barkley 2005, 2006f; Barkley et al., 1990b, 1991; Flick, 1998; Loney et al., 1981).
At this stage of development, unfortunately, poor self-concept, low self- esteem, and poor self-confidence are common among students with ADHD. They also may have anxiety or depression. Moreover, they tend to find social acceptance in bonding with other teenagers who have similar problems which may result in involvement in risk-taking behaviour such as antisocial behaviour or use of alcohol or other addictive substances (Barkley, 2005, 2006f; Farrington et al., 1990; Flick, 1998; Huesmann et al., 1984).
Adulthood: At this stage of development, continuation of the core of ADHD
symptoms is highly expected among individuals with ADHD. According to Barkley,
only 10-20% of children with ADHD reach adulthood free of any psychiatric diagnosis, functioning well, and without significant symptoms of their disorder. The rest continue having many of the same problems they
had as children and then as teenagers, and dealing with those problems for so long can take a tragic toll (2005, p.95).
Mannuzza et al., (1991) found that 43% of young adults with a history of ADHD still manifested a full syndrome of ADHD symptoms, 32% met the diagnostic criteria for antisocial personality disorder, and 10% were involved in substance abuse. Mannuzza et al. suggested that, other than antisocial problems and substance abuse, individuals with ADHD are not at risk of developing any disorder. However, elsewhere (e.g. Barkley, 2005, 2006f; Biederman et al., 1987, 1991; Weiss and Hechtman, 1993) it has been shown that individuals with ADHD are at greater risks of internalizing work, friendships, marital and vocational problems. Moreover, these problems are significantly associated with some factors such as the emotional climate of the home (e.g. the mental health of family members), emotional stability (e.g. level of aggression), intelligence, hyperactivity, and relationships with adults. For example, individuals with ADHD are dismissed from jobs are more likely to have been so for reasons related to hyperactivity, antisocial behaviours and their relationships with adults.
To conclude, although the studies mentioned above have confirmed that the symptoms of ADHD may change somewhat as the child develops and most children do not “outgrow” ADHD some asserted that the early symptoms of ADHD are transient problems of young children which the child will “outgrow” by adolescence (Duncan et al., 2007; Shaw et al., 2007).
The current researcher has chosen to address the developmental stages of ADHD because these stages are highly important in identifying children with ADHD. If parents and teachers were not aware of how a similar problem or behaviour will present differently at different maturational stages or if they ignore the signs of ADHD the result will be the loss of valuable treatment time
for the child. Cohen and colleagues (1981) estimated that at least 60% to 70% of children who are later diagnosed with ADHD could have been identified during the preschool years. Moreover, from both the developmental stages of creativity and ADHD it is reasonably fair to consider children aged 9 to 10 as vulnerable, therefore the present study is applied to a sample of these children.